Impact of a centralized population health pharmacy program on value-based Medicare patients.

BACKGROUND: Memorial Healthcare System (MHS) participated in the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement Advanced value-based program aimed to improve patient care and reduce health care costs. Challenges with medication therapy problems (MTPs) led to the development of a centralized tele-health population health pharmacy program. This innovative approach aimed to provide comprehensive postdischarge medication support and resolve MTPs during the 90-day risk period. OBJECTIVES: The program aimed to provide longitudinal medication support, resolve MTPs, and affect 90-day readmission rates. PRACTICE DESCRIPTION: MHS established uniform workflows, a pharmacy task force, and a dual pharmacy team approach with population health registered nurses (PHRNs). The population health pharmacists (PHPs) conducted postdischarge telephonic encounters to resolve MTPs longitudinally throughout the risk period. PRACTICE INNOVATION: The program used a centralized tele-health model with electronic health record-integrated tools. It targeted readmission rates up to 90 days, beyond the conventional 30-day period. PHPs collaborated with onsite transitions of care pharmacists, PHRNs, and health care professionals for coordinated patient care and MTP resolution. EVALUATION METHODS: A retrospective analysis using descriptive statistics, a Kruskal-Wallis test, and multivariate regression models after stratifying patients into 4 groups were used to assess MTP resolution rates and differences in readmission rates. RESULTS: Over 7 months, PHPs completed 801 telephonic visits, identifying 433 MTPs with a 94% resolution rate. The program led to a statistically significant reduction in 90-day readmission rates from 35% to a range of 10%-17% (P < 0.01). CONCLUSION: The centralized tele-health population health pharmacy program improved patient outcomes, resolved MTPs, and reduced readmission rates. The program serves as a model for integrating pharmacists into value-based care initiatives.

Bictegravir/emtricitabine/tenofovir alafenamide in a virologically suppressed adult with HIV and end-stage renal disease on chronic peritoneal dialysis: A case report.

Despite increasing rates of renal replacement therapy, data supporting the safe and effective use of HIV treatment guidelines preferred regimens in people on hemodialysis or peritoneal dialysis is limited. Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is a guideline recommended initial regimen for most people with HIV with FDA-approval for use in virologically suppressed people receiving chronic hemodialysis; however, the safety and efficacy of BIC/FTC/TAF remains unknown when used in patients on chronic ambulatory peritoneal dialysis (CAPD). We report the first case of BIC/FTC/TAF use in CAPD.

Management of Partial Hydatidiform Mole and Subsequent Intrauterine Adhesions: A Case Report and Literature Review.

BACKGROUND: Gestational trophoblastic disease (GTD) originates from placental tissue and is among rare human tumors that can be cured even in the presence of widespread metastases. The most common form of GTD is hydatidiform mole (HM), commonly referred to as molar pregnancy. Molar pregnancies have the potential to locally invade the uterus and metastasize and result as a result ofgestational trophoblastic neoplasia. Intrauterine adhesions (IUAs) is a condition where scar tissue develops within the uterine cavity, often following a procedure. Hysteroscopy has been established as the criterion standard for the diagnosis of IUAs, although the optimal adjuvant treatment after surgical intervention remains unclear. . CASE: A 35-year-old-female underwent suction curettage a week after the detection of a molar pregnancy. Two months later, she suffered from amenorrhea and hormonal therapy was initiated. Saline-infusion sonogram was tried and failed due to cervical stenosis. IUAs leading to scar tissue developed along with uterine polyps. Hysteroscopy successfully lysed IUAs and uterine polyps. The patient conceived two months after stopping hormonal therapy and proceeded to a pregnancy which resulted in a healthy live birth. CONCLUSION: Although the etiology of the patient's molar pregnancy is still unknown, this report demonstrates the need to utilize hysteroscopy as a primary and early mode of treatment if IUAs are found in patients along with providing adjuvant treatment while utilizing clinical judgement in order to prevent IUAs recurrence. The patient conceived four months after the hysteroscopy resulting in a healthy live birth.